The biological agent most likely to be used as a biological weapon is Bacillus anthracis, which causes the anthrax infectious disease. During the Cold War, it was present in large quantities in the military arsenals of some states, and at the beginning of the 21st century was used in a series of small bioterrorist attacks. In case of occurrence of events using Bacillus anthracis, urgent and adequate qualitative and quantitative response measures are needed to manage the consequences of the attack and to reduce the effects on public health. These include complex and well-coordinated activities to ensure medical intervention for the prophylaxis, treatment and recovery of patients. General prophylaxis is achieved by vaccination, individual and collective CBRN protection, decontamination, partial and total sanitary treatment, microbiological analysis for the detection, identification and confirmation of the biological agent. Therapy for disease induced by weaponized B. anthracis differs from classic antrax disease regarding antibiotics, doses and time, resulting a large antibiotic consumption per case. Complete recovery of the patients is achieved not only in terms of restoring normal biological parameters, but also in terms of the organism’s "sterilisation" regarding the causal biological agent.
All large armies (EU and/or NATO) have pharmaceutical production facilities to provide the necessary antidotes for the troops and the population: The French Army Medical Directorate produces many military-specific pharmaceutical products in its own laboratory, the Turkish Army owns its own medicines factory, including CBRN antidotes, the US Army, in addition to a sustained drug purchase program in the pharmaceutical industry has launched a new concept: Pharmacy on demand. Providing the armed forces with antidotes is a necessity, the concept for their endowement in this sense can be based on imports (sometimes impossible to achieve) or on the national development of a specialized production structure. The design or construction of a specific production capacity for antidotes can be accomplished on multiple variants, with a complexity proportional to the identified need. The total costs are high, but the objective and implementation of effective antidote supply mechanisms is a security guarantee for the armed forces and the civilian population (through commercialization to allied forces), given the risks of terrorist threats and hybrid warfare.
The “volatile” international context requires the strengthening of the national security measures, including in the field of CBRN and public health. The medical countermeasures for the defense are based ultimately on the prophylactic treatment (pre-exposure, intra-exposure and post-exposure) and on the curative treatment (of emergency, maintenance and recovery) of the contaminated and the sick. Depending on the rapid and correct etiological diagnosis, the appropriate treatment is immediately applied. Although in times of peace this scenario is almost non-existent, during war or terrorist attack it can be a mass pathology, like an explosive epidemic, that requires specific therapeutic means. Military medicine had and has the conceptual capacity to make antidotes for CBRN medical protection; some have been patented and/or produced as experimental models, but it has no manufacturing capacity anymore.
Making medical countermeasures requires documentation to assess vulnerabilities, threats and operational risks and bioterrorism through the collection and processing of specific multidisciplinary data in human medicine, veterinary, phytosanitary, the environment, defense and national security, etc. Based on retrospective data and late information (medical intelligence), we can estimate the prospective risk to public health, respectively for troops and civilian population in a given area, the area of operations. The biological military or bioterrorist attack, whether overtly or masqueraded as human or animal epidemics can cause a major biological crisis for troops and the civilian population, for domestic and wild animals, for crops or wild plants or for the environment, which remains contaminated. Therefore, it is important to constantly monitor the situation of infectious diseases in the area of responsibility (national territory, operations theaters) to assess vulnerability, threat and bioterrorist risk but also for making medical anti-bioterrorist countermeasures, which can only be effective by genuine cooperation between all specialized structures of the Ministry of Defense, other departments and the civil society.
Military Medical Service is able for detection, identification and confirmation of biological agents; it is part of medical protection against CBRN weapons. We are specialized capabilities for in vitro tests, under construction, the maximum containment laboratory designed for work with Risk Group Microorganisms. An efficient primary containment system must be in place, consisting of one or a combination of the following: Class III safety cabinet laboratory, passage of two doors, suit laboratory, controlled access, controlled air system. Negative pressure in the facility, supply and exhaust air must be HEPA-filtered, decontamination of effluents, sterilization of waste and materials, airlock entry ports for specimens, materials and animals must be provided etc. Complementary is an Animal facility for in vivo tests. This is suitable for work with animals that are deliberately inoculated with microorganisms in Risk Group.
Electroporation is considered a new start-up in the treatment of various tumors; currently, researches are being conducted in order to develop this technology with medical applications. The technique consists in the significant increase in the electrical conductivity and permeability of the plasma membrane of cells resulting from the application of an external electric field. It is routinely used in molecular biology to transform bacteria, yeast, protoplasts and is performed using the electroporators. Currently, the process seems to be a real solution that enables a targeted drug to act with maximum efficiency on cells and tissues requiring treatment, resulting in obtaining a good therapeutic effect without major side effects. Therefore, pharmaceutical companies are trying to demonstrate through preclinical studies the potential efficacy of this technology, succeeding in recent years to achieve important steps in this direction.
Zika virus, the etiological agent of Zika fever, is transmitted by mosquitoes and has been affecting the South American continent starting with 2015. It was reported in several European countries, carried by the people who returned from Latin America, as reported by the health authorities in those countries. Today, according to the World Health Organization (WHO), the virus suspected to cause serious birth defects in the fetus has also been confirmed in 21 of the 55 countries of South America, but also in other states from Europe and North America. Zika virus is a single stranded positive sense RNA virus belonging to Flavivirus genus (family Flaviviridae) and was first identified in 1947 in Uganda rainforest Zika. The increased number of cases of microcephaly, in children from northern Brazil, suggested a connection with Zika virus, but it has not yet been proven. Also, the virus can be transmitted sexually and through blood or blood products. Diagnosis of the infection is made using Polymerase Chain Reaction (PCR). So far, there is no specific antiviral treatment or vaccine against the infection with Zika virus. The best form of prevention is to avoid mosquito bites. WHO has estimated that the spread of Zika virus, transmitted through mosquito bite, is “a global public health emergency”. The priority is to protect pregnant women and to control the mosquitoes.
Escherichia coli is the species of the genus Escherichia with the greatest epidemiological impact. Escherichia coli infections are found mainly in places with poor hygiene; the infants with ages between 1 and 3 years old are included in the category with the highest risk. It is a "fecal-oral" transmission mechanism as a result of consumption of contaminated food or water, or by "dirty hands". The foods most commonly implicated in the transmission of the infection are unpasteurized milk and milk products, beef, especially the one insufficiently cooked, unpasteurized fruit juice, lettuce and insufficiently washed vegetables. The disease has been reported worldwide, being described numerous episodes of infection with Escherichia coli that caused multiple illnesses and deaths. Escherichia coli has three types of antigens: antigen "O" (somatic), antigen "H" (flagella) and antigen "K" (capsular). Clinical manifestations are present in the form of non-specific diarrhea, a dysentery form of enteritis, choleriform enteritis, hemorrhagic colitis and hemolytic uremic syndrome (HUS). The Escherichia coli infection diagnosis is made by identifying the etiologic agent and/or by highlighting the VTI toxin in the feces. The treatment consists in precautionary antibiotherapy, hydrodynamics and electrolyte rebalancing, blood transfusions and dialysis, if in the case of renal failure. The prevention of infections with Escherichia coli is achieved by personal hygiene, food hygiene and work hygiene.
Clostridium difficile (C. difficile) is a Gram-positive sporogenous bacillus strictly anaerobic, which in the last decade has became the most important anaerobic bacterium in nosocomial human pathology. Cl.dificile is the etiological agent of more than 20% of diarrhea postantibiotics, over 95% of pseudomembranous colitis and the first cause of nosocomial infectious diarrhea in adults. Although this bacterium usually colonizes the intestine of vertebrates (the normal microbiota), the toxinogenic strains (tcdA and tcdB) are pathogenic in the digestive tract. Given the excessive use of antibiotics and the increased spores resistance, it is possible an environment contamination, with strains which may already be resistant to antibiotics. The main causes of this infection are decreased resistance to antibiotic-induced colonization, contamination with a pathogenic strain of Cl.difficile, secretion of A and/or B toxins and deficient immune response. Due to the increasing worldwide incidence of infections with C. difficile on one hand and to the discovery of new ways of transmitting the infection according with some studies regarding the genetic diversity of bacterium strains on the other hand, a new approach is necessary for C. difficile related topics..
